Recent review of the current practices of Active Surveillance

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A rather detailed (124 references) review by researchers at Tufts Medical Center (Boston) of the current practices of Active Surveillance (AS) for early "low-risk" prostate cancer has been published recently in the ls of Internal Medicine. A free PDF of the full paper is available at: http://www.annals.org/content/156/8/582.full.pdf+htmlThe full paper is also available on-line at: http://tinyurl.com/6nplpoaOf potential interest is Table 3, which summarizes criteria for selection and monitoring of AS patients from 16 major AS programs. The table is also available as a PowerPoint Slide: http://tinyurl.com/83elarj

The PubMed abstract is below. I found the abstract conclusion statement, "Evidence is insufficient to assess whether AS is an appropriate option for men with localized prostate cancer." a bit different than the actual conclusion of the paper, which says "The comparative effectiveness of AS versus immediate active treatment remains unclear." There remain questions on the comparative effectiveness of all major types of prostate cancer treatment (RP vs. robotic RP vs. various radiation modalities), but I suspect few would conclude that any of those common treatments was not "an appropriate option for men with localized prostate cancer."

The Best to You and Yours!Jon in Nevada

----PubMed Abstract ------------------

Ann Intern Med. 2012 Apr 17;156(8):582-90. Epub 2012 Feb 20.Active surveillance in men with localized prostate cancer: a systematic review.Dahabreh IJ, Chung M, Balk EM, Yu WW, Mathew P, Lau J, Ip S.Tufts Evidence-based Practice Center, Institute for Clinical Research and Health Policy Studies, and Tufts Medical Center, Boston, Massachusetts.

Background: Active surveillance (AS) and watchful waiting (WW) have been proposed as management strategies for low-risk, localized prostate cancer.

Purpose: To systematically review strategies for observational management of prostate cancer (AS or WW), factors affecting their utilization, and comparative effectiveness of observational management versus immediate treatment with curative intent.

Data Sources: MEDLINE and Cochrane databases (from inception to August 2011). Study Selection: Screened abstracts and reviewed full-text publications to identify eligible studies.

Data Extraction: One reviewer extracted data, and another verified quantitative data. Two independent reviewers rated study quality and strength of evidence for comparative effectiveness.

Data Synthesis: Sixteen independent cohorts defined AS, 42 studies evaluated factors that affect the use of observational strategies, and 2 evidence reports and 22 recent studies reported comparisons of WW versus treatment with curative intent. The most common eligibility criteria for AS were tumor stage (all cohorts), Gleason score (12 cohorts), prostate-specific antigen (PSA) concentration (10 cohorts), and number of biopsy cores positive for cancer (8 cohorts). For monitoring, studies used combinations of periodic PSA testing (all cohorts), digital rectal examination (14 cohorts), and rebiopsy (14 cohorts). Predictors of receiving no active treatment included older age, comorbid conditions, lower Gleason score, tumor stage, PSA concentration, and favorable risk group. No published studies compared AS with immediate treatment with curative intent. Watchful waiting was generally less effective than treatment with curative intent; however, applicability to contemporary patients may be limited.

Limitations: Active surveillance and WW often could not be differentiated in the reviewed studies. Published randomized trials have assessed only WW and did not enroll patients diagnosed by PSA screening.

Conclusion: Evidence is insufficient to assess whether AS is an appropriate option for men with localized prostate cancer. A standard definition of AS that clearly distinguishes it from WW is needed to clarify scientific discourse.

PMID: 22351515